Medicare Part B typically does cover physical therapy if it is considered medically necessary by a doctor or therapist.
If your physical therapy is not considered medically necessary, however, you are responsible for 100% of the costs.
If Medicare Part B covers your physical therapy, Medicare will typically pay 80% of the approved cost amount, and you will pay 20% after you meet your annual Part B deductible.
In 2019, the Medicare Part B deductible is $185 per year.
To find out how much your physical therapy services will likely cost, speak with your therapist or therapy provider before receiving services.
In 2018, congress eliminated the limits on how much Medicare pays for therapy services in a single year. This means that in qualifying cases, Medicare Part B will continue to help cover some of the costs of your physical therapy, no matter how high your accumulated costs grow in the year.
If your therapy services cost at least $2,010 in 2018 and going forward, your therapy provider must add a notation to your therapy claim, confirming that your therapy services are reasonable and necessary. Your therapist must also add information to your medical records explaining why the services are medically necessary.
If your physical therapy services are not medically necessary, your therapy provider must provide you with a written notice before providing services.
Physical therapy services are generally covered for anyone with Medicare part B as long as the services are considered medically necessary.
Medicare Advantage plans (Medicare Part C) are sold by private insurance companies and combine the benefits covered by Medicare Part A and Part B into one single plan.
This means that Medicare Advantage plans will cover your physical therapy services that would qualify for Medicare Part B coverage as listed above.
Many Medicare Advantage plans may also provide benefits that aren’t covered by Original Medicare. Some of these additional benefits can include prescription drug coverage and membership to fitness and wellness programs such as Silver Sneakers.
To learn more about Medicare Advantage plans in your area that cover physical therapy, speak with a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.
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